What Keeps Pharma Folk Awake at Night?
With the Halloween holiday looming, we ask 8 pharma experts to share their biggest fears.
It’s Halloween - a time for scary movies, sleepless nights, suspicion of the shadows, and coming face-to-face with our biggest fears. But what are the fears of the pharma industry? We consult 8 pharma experts and pose the question: “What keeps you awake at night?”
Nigel Hughes, Director of Integrative Healthcare Informatics, Janssen R&D, provides the sound bite that lays the overarching themes for what seems to be of most concern to experts and innovators in the pharma industry: “The pharmaceutical industry stands the risk of being less and less relevant to healthcare in the future, in part due to the evolution of technologies that go beyond the pill, from bio-engineering to cyber-augmentation or disease interception. And, in part, due to being too slow to evolve its own thinking around being outcome and solution orientated versus the traditional prescription-based model.” He also believes that non-traditional entrants are ever increasing in presence, reach and action, especially in the domain of data and real-world evidence. He asks, “How quickly can new technologies disrupt the existing paradigm of the industry?”
Kamal Biswas, Author of ‘Pharma’s Prescription’ and Partner at Infosys Consulting, expands on Hughes’ concerns by providing some background into what is preventing the pharma industry from being at the forefront of technological innovation and modernization. “Pharma is just too slow to evolve its thinking and in adopting technology that can make better products available to patients who need it faster,” he affirms. He provided an example of the industry’s slowness to adapt to new technologies: “The pharmaceutical industry has operated manually for decades. They prefer this and many regulators want to operate that way. People still execute processes manually, sign papers, and keep hard copies for long periods of time. These operations should be digitized for efficiency and improvement, and to reduce errors. This is changing - regulators have started accepting e-submissions - but not as fast as expected, or as fast as it should be; not as scalable as it should be.”
According to Biswas, this slowness to adapt will catch the pharma industry flat-footed: “Digital technology will change the healthcare world – 3D printing will reshape pharmaceutical manufacturing and distribution completely; it will change the way we take medicine, the way we get medicine, and even our treatment options.” With this in mind, he poses the question, “Is the pharma industry sensing this and changing fast enough?” For Biswas, the answer is “no.”
Dr Bertalan Mesko, Medical Futurist and author of ‘My Health: Upgraded’ shares his thoughts about the apathy of the pharma industry to adapt to the changing topography of medical and healthcare provision, as well as the new trends in drug manufacturing that concern him.
Mesko warns, “The 3D printing of drugs opens up a new field in pharma as these drugs are created with a different method. In addition, it doesn't require the chemical manufacturing older drugs did.” He believes 3D printing is a “disruptive technology” because it will eventually cause the existing pharma system “to break down to pieces to build an entirely new system.” He asserts, “For pharma, this means they might not just lose profit to start-ups that implement disruptive technologies, but they might lose an entire business.”
He also warns of the need for pharma to remain flexible in terms of the ‘empowered patient. Whereas patient empowerment today means the patients’ views and perceptions of their healthcare provision are given prominence, Mesko warns that empowered patients of the near future may be different: “Empowered patients acquire biotech companies to run their own clinical trials. They are motivated and informed and have a different relationship with pharma companies than before.”
Pedro Alsina Mier, Director of Institutional Relations at Sanofi Pasteur, MSD, highlights the sluggishness of the pharma industry in terms of innovation in the field of vaccine administration. Indeed, it is “the future of vaccines” that keeps Mier awake at night. “The pharmaceutical industry needs to find new ways of administration, avoiding shots and solving the issue of the ‘cold chain’ to facilitate the vaccination campaigns in areas difficult to access,” he says.
Delays in finding new ways of administering vaccines fuels the worldwide problem of anti-vaccine movements. According to Mier, the past success of vaccines is its own undoing: “Vaccines dramatically reduced and even eradicated terrible infectious diseases. Today, the focus is not on eradicating the disease itself, but on controlling the potential side-effects that arise from complications of these infectious diseases.”
Mier won’t be sitting back, however, but is tackling this fear head on: “We are going to have several options for improving vaccine administration, but the most interesting is using biotech to infuse vegetables or fruits, including proteins with immunogenic properties. There are other possibilities – the use of microorganisms like Lactobacillus and nanotechnology, for example.”
Dr Katrina Firlik, Co-founder and Chief Medical Officer at HealthPrize Technologies, perceives similar problems and believes slowness of innovation seems to fuel a mistrust of the drug industry: “The lack of compelling ways to communicate the risk of drugs versus the risk of the disease contributes to a worldwide problem of non-adherence.” She explains, “I believe that scepticism, fear, and suspicions regarding modern medications are a problem in both wealthy and developing countries, particularly where strong traditional health beliefs trump modern therapy. A number of things foster this fear - the scary package insert that lists every possible side-effect, the fast talk at the end of TV commercials that also highlights scary side-effects, and anecdotes by friends, family, and on social media regarding side-effects that may or may not be drug-related. This fear of drugs is a serious underlying reason for medication non-adherence.” She cautions that, “There are risks with all medications and all forms of therapy. However, there are also risks in doing nothing.”
Ray Chepesiuk, CEO of the Pharmaceutical Advertising Advisory Board, also echoes Firlik’s fears around communication: “My fear is that not all doctors will receive communications from pharma companies; 53% of doctors from the US don’t see sales reps because they don’t trust or value their information.” Over all, Chepesiuk believes that pharma need to engender trust in healthcare professionals and patients to build a better bridge to facilitate knowledge transfer.
These fears around trust and pharma’s reputation are shared by Mike Rea, CEO of IDEA Pharma. “What keeps me awake at night is pharma’s reputation,” says Rea. “The spectre of drug pricing has made it ‘above the fold’ and the situation where pharma has failed to self-police has led to Joker-like villains such as Martin Shkreli providing a focal point for the ire of the general public. If there is a link between prices and innovation - and although indirect, there is - then the risk is that the debate is taken away from pharma’s control.”
“We have all watched reaction increase to the point of ‘someone must do something,’ wondering if this is the straw that breaks the camel’s back,” expands Rea. “Sovaldi raised the issue to the ‘everyone feels entitled to have an opinion’ level, and introduced the view that pharma simply prices where it can. Managing our reputation, as far as the lobbying groups like PhRMA and ABPI were concerned, was wholly about defending at all costs.”
Now, according to Rea, “The public has a face (and, oh, how punchable a face), and a name, and a screw-you attitude, and the headlines read ‘Big Pharma,’ not ‘small, insignificant pharma.’” The change to pharma’s reputation, away from ‘Big Oil,’ ‘Big Tobacco,’ or bankers, needed to be in a positive direction, but Rea feels it wasn’t and could “come back to haunt us.”
David Coleiro, Partner at Healthcare Brand Building Agency Strategic North, provides a number of key ‘nightmares’ in terms of the challenges facing healthcare, of which there are many. His first concern is health data: “It could be a huge benefit, but how do we make it accessible, mobile and secure? Sensitivities mean that one breach could send us back 10 years.” Behavior change is another concern: “Unless we empower patients and the public to embrace different health behaviors, we won’t be able to afford healthcare.”
“There is also the perceived relevance of the pharmaceutical industry as a key partner in addressing such challenges when we are often seen as peripheral providers of pills,” he adds. While a range of new entrants, including technology providers, are driving change, Coleiro highlights that the industry remains justifying its place: “How do we convince governments of the priority of health and the value of medicines so they continue to fund the development and implementation of new innovations?” He also highlights the need for pharma to adapt its model to new funding pressures and approaches such as performance related payment. He says “We are enjoying a period of fantastic innovation, but such challenges put the sustainability of the industry in question”.
So, what will be keeping pharma folk awake this Halloween and beyond? Most of the experts we spoke to are concerned by the lack of industry preparedness for new developments in technology and sudden global shocks. Two experts point to at least two fields where the pharma industry’s sluggishness in adapting to emergent technology is creating real-world problems: development of vaccines and medication non-adherence. And there are also fears around pharma’s reputation with the public and how this could ultimately be just as much a nightmare in the future as it is now.
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